Providers to advise of ''Medical Miranda''
Article Abstract:
Medical 'Miranda' warnings consist of a set of patient rights that health care provider organizations are now required to present to patients. This is in accordance with the Patient Self-Determination Act, passed as part of the omnibus budget bill in November 1990. Under this law, organizations must advise the patient of his right to refuse care and of the option of naming a proxy in the event that he becomes incompetent. This must be done if the organization is to continue to receive Medicare or Medicaid reimbursement. Providers are to develop written policies on the subject of refusing care, to give such information to the patient when he is admitted to ensure compliance with advance directives, and to educate staff and the community concerning such directives. Information is to be provided to health care organizations by state agencies (state laws concerning refusal of care vary widely) and the US Department of Health and Human Services. The American Medical Association is preparing a model advance directive form, and the American Hospital Association is preparing a kit on the subject. Some Health Maintenance Organizations (HMOs) have also moved quickly to comply with the law. One issue is the point at which the availability of living wills should be made clear to the patient. In general, the patient should be told sooner, rather than later. HMOs link advance directives to physician training. Many physicians do not know how to discuss such issues with their patients, and many patients are unfamiliar with the concept of a living will. Physicians who move unstable, indigent patients to other facilities (dumping) will gain increased protection under this new law, which provides more due process than has been previously afforded to the physician. To incur a fine, violation of laws concerning improper transfer must now be 'negligent' rather than 'knowing'. However, people who report such violations also now have increased protection. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1991
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'Best data yet' say air pollution kills below levels currently considered safe
Article Abstract:
Current acceptable standards for fine-particle air pollution may be too high. Fine particles are those with a diameter of 2.5 micrograms or less, and the most dangerous appear to be by-products of burning fuel. A recent longterm study comparing six cities found that the rate of premature death was 26% higher in the cities with the most air pollution than in those with the least. The finding that death risks are more strongly associated with particulate matter and sulfates than with ozone and sulfur dioxide could dramatically change the focus of air pollution control efforts. Another study found that particulate matter stays in the lungs much longer than previously thought. People with respiratory diseases, including asthma, cardiovascular disease and chronic obstructive pulmonary disease, appear to be affected the most. Until the Environmental Protection Agency (EPA) revises its standards for particulate matter, physicians and patients should be aware of the risks.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1993
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